James T. McLaughlin

Clinical and theoretical aspects of enactment

Enactment as a concept can serve analytic discourse through its established meaning of an act intended strongly to influence, persuade, or force another to react. We might agree to use the term in two complementary ways: Broadly, enactment can designate all behaviors of both parties in the analytic relationship, even verbal, in consequence of the intensification of the action intent of our words created by the constraints and regressive push induced by the analytic rules and frame. Patient and analyst are vulnerable to falling back on behaviors that actualize their intentions, doing so in ways motivated by and reflecting transference hopes, fears, and compromises shaped in their developmental past. Specifically, enactment can then be defined as those regressive (defensive) interactions between the pair experienced by either as a consequence of the behavior of the other. While nominally an interpersonal perspective, this concept of enactment facilitates more balanced attention to the involvement of both parties and to the intrapsychic dynamics in both that specifically shape their interactions. A clinical vignette illustrates the analysts contributions to enactment, especially those reflecting his reactivated conflicts and their relation to his theoretical and technical preferences.

Enactments in psychoanalysis

H E CHAIRhIAN INTRODUCED 111s OVERVIELV with the promise that T the panel would explore and give some definition to what we think we mean when we speak of enactineiit in the psychoanalytic situation. He noted that enactment is a word we have borrowed from common discourse, just as Freud borrowed words in his time. Yet the word itself seems not to have been addressed in our literature until 1986, by Jacobs. Increasingly, analysts are inclined to use the word enactment in idiosyncratic fashion, and it has not become a part of our official glossary. In ordinary speech and dictionary definition, the word enactment suggests an action whose purpose, force, and intention are raised to high intensity. That intensity gives concreteness and actuality to its impact on the implicit other person in the field of action. It is then an act, the intention of which is to persuade, or to force the other into a reciprocal action. The message is carried in words, silence, actions, and particularly nonverbal communications. All of us, analysts and patients alike, as infants and as children learned to recognize and to react to nonverbal communications long before the words were there to approximate, amplify, or negate those nonverbal ways. All of us have long since learned how to appeal, to coerce, and to force in stating our needs and emotions with posture, gesture, and nonverbal sounds long before mastering the diplomacy of words. Those earliest capacities have only been added to and not relinquished while words became known and dominant. T o appreciate the imperatives of this need and the use of a full repertoire of evocativecoercive capabilities, especially as deployed in the analytic relationship, requires the perspective that our concepts of transference afford us. hlclaughlin finds especially useful the broad view of transference as an inherent tendency to impose the organizing of prior perceptions of experience upon the present, a powerful shaping of the psychic reality of each of us. Put differently: our deepest hopes for what we may find the world to be, and our fears for what it will be, are our

The analyst and the Hippocratic oath.

An important factor in shaping the relationship between patient and analyst is the identity of the therapist as physician. Each of us who first became a doctor of medicine before he then became psychiatrist and psychoanalyst had driving reasons for donning the physicians cloak, and powerful fantasies concerning the role of the doctor. We saw in him both license and limitation, scope and stricture, for our manifold personal strivings and conflicts. TVhile this cluster of concepts and ideals about the physician that each of us possesses is in part individually determined, it also reflects the meaning of the physician as set down with sharp insistence by the culture in which we live. Thus, the interplay between the strivings and conflicts of the individual and the complex of taboos and freedoms which make up the figure of the doctor in our society constitutes an absorbing subject for reflection. Others have written well upon the activities of the physician and the analyst as gratification for pregenital part-instinctual strivings (1 1, 7), as attempted solutions for loneliness and isoIation (13), and as gratifying creative and reparative work (10, 6, 12). What is expressed here is in no way contradictory, but rather views theseissues from the standpoint of identity in an effort to focus upon the significance of the model of the physician in general and the psychoanalyst in particular, and to sketch out the relatedness between the individual dynamisms of the analyst and those implicit to tile cultural identity of the healer. The heritage of the doctor in Western civilization derives from many sources clustering around a central core of the Hippocratic

The Nonreporting Training Analyst, the Analysis, and the Institute

LIVELY CONTROVERSY HAS GONE ON in psychoanalytic education regarding the involvement of the training analyst in the A progression of his analysand through the training program. The issue has been variously conceptualized. Most broadly it has been viewed as just one instance of the inevitable syncretistic dilemma of the training analyst as he attempts to handle incompatible functions and responsibilities (Lewin and ROSS, 1960). Still broadly, it has been considered the inescapable consequence of both training analyst’s and analysand’s being caught up in the intricate networks of communication and common knowledge that exist in a small group organized around shared endeavors and identifications (Grotjahn, 1954). More narrowly it has been placed in the context of the training analyst’s position of power and authority, enacted or implicit, as a member of an administrative-academic body standing in judgment on the candidate’s performance. Most restrictedly it has been conceptualized as the training analyst’s reporting to his institute about his candidate; i.e., rendering opinion about, and exercising administrative inff uence upon, his analysand’s progression through the various stages of his analytic training. The failure to keep perspective on these different conceptual levels has led to considerable confusion and perhaps unnecessary

A classic revisited : Loewald on the therapeutic action of psychoanalysis

Versions of the following papers were presented at the panel “Psychoanalytic Classics Revisited: Hans Loewalds ‘On the Therapeutic Action of Psychoanalysis’” (Gerald I. Fogel, chair) at the meetings of the American Psychoanalytic Association, December 1993. As a tribute to Loewalds lifetime of achievement, and in belated recognition of his preeminent position in the field of psychoanalysis, the exchange appears here almost in its entirety, rather than as a conventional panel report.

The Listening Process. By Robert Langs.

i n the final chapter, “Theory and Technique in the Treatment of Anorexia Nervosa,” Sours states that just as there is no one anorexia, 50 there is no one treatment applicable for all sufferers of this disease. The first phase of any therapy is to treat the acute life-threatening disturbance. The self-starving patient in a state of profound cachexia and toxicity requires immediate medical and psychiatric intervention and hospitalization to restore and maintain life. Only after the patient has returned to a normal nutritional state can the second phase of treatment be pursued. This is the time for long-term treatment of the anorectic’s pathological character. Sours reviews all the different treatment modalities available, the organic as well as the psychological ones. To my mind, an effective treatment of the anorectic patient must uncover the unconscious symbolic meaning of thinness, the displacement from the internalized object to food, and the presence of the repressed cannibalistic fantasies. This task is one that can be accomplished only through analysis. Starving to Death in u Sea of Objects is a beautiful book in which scholarship, rich clinical experience, and poetic imagination are combined. Sours’s use of vivid clinical vignettes to illustrate the thorough theoretical formulations make this work inestimably valuable for both the clinician and the layman.

Committees of the Board on Professional Standards

The Board on Professional Standards and its committees: Francis McLaughlin, Chairman. Francis hlchughlin opened the panel presentation by alluding to the current ferment in organized psychoanalysis, much of it focused upon overt issues of criteria and categories of membership in our Association. This, he felt, pointed to a growing and challenging interest in the philosophy and standards of psychoanalytic education. The place and functions of the Board on Professional Standards and its various committees in relation to these issues often seem to be not clearly understood, for reasons that include a general lack of information regarding the organization of the Association itself. The Association in its most general sense is an aggregate of individual psychoanalysts who vote for their officers and by-laws. Clustered locally or regionally into Societies, they function collectively to designate Society representatives to the Executive Council to direct and transact business pertinent to a scientific and professional organization. Clustered into faculties and psychoanalytic institutes, they designate institute representatives (two Fellows for each of the now 21 accredited institutes) to the Board on Professional Standards to direct and transact business pertinent to an educational organization. Only a fraction of the total membership is involved and represented in these institute and Board functions, and the result for the rest seems too often to have been a sense of distancing from the educational affairs of the Association and a perception of the Board as arbitrary and nonprogressive.